Saturday, May 3, 2014

Oh SAMHSA, Where Art Thou?

Forced treatment already exists. It's called prison.

What did Newtown mean, if we can’t get help for children and
families in mental health crisis?

I have a confession to make. Until about a year ago, I had
no idea what SAMHSA was. I had never even heard of it. My son has struggled
with serious behavioral issues for more than nine years, which we now know are
caused by his bipolar disorder. We were working with a small army of social
workers, counselors, school personnel, psychiatrists, therapists—and I was
well-versed in a small textbook of acronyms like IEP, SMI, ADHD, ODD, ADA, etc.
But not one time was SAMHSA or any of its programs ever mentioned to me as a
resource.

I’m going to assume that you’re like me, that you also have
no idea what SAMHSA is or what it stands for. It’s the Substance Abuse and
Mental Health Services Administration, and it’s important because it gives out
a ton of grant money—they have requested $3.6 billion for next year—to
community organizations, many of which I also personally support with my own
time and money. According to the agency’s own website, “Congress established the
Substance Abuse and Mental Health Services Administration (SAMHSA) in 1992 to
make substance use and mental disorder information, services, and research more
accessible.”

Well,
to put it bluntly, if that’s its mission, SAMHSA sucks.

A New Kind of Stigma

One of SAMHSA’s top priorities is the elimination of stigma
that surrounds mental illness. And that’s important, because stigma harms
children and families. DJ Jaffe of mentalillnesspolicy.org recently argued that
stigma does not exist—that prejudice and discrimination are the real problem. I
disagree with him on the first point, but could not agree more fervently with
the second.

You don’t have to go any farther than the SAMHSA webpage to see an example of prejudice and discrimination against people with serious
mental illness. Look around. Can you find anything—even the littlest thing—that
talks about SMI? The message I get from SAMHSA is this: “Behavioral health is
essential to health. Prevention Works. People Recover. Treatment is effective.”

I wish this were always true. For people with serious mental
illness, people like my son, too often it’s not.

Pretty words, no
substance

SAMHSA, the very organization tasked with serving children
who have mental illness and their families, creates stigma by refusing to talk
about—let alone provide solutions for—the inconvenient truths that plague too
many of us: violence, prison, homelessness, fear. In fact, in its focus on “behavioral
health” and “recovery,” I would propose that SAMHSA actually creates its own
pernicious, subversive form of stigmatization within the very community that is
supposed to be supporting people with mental illness.

Behavioral health implies choice. So does recovery. SAMHSA
promotes a consumer model, where people with behavioral problems choose to get
help and recover. The problem is that this approach does not reflect reality. For
many people who suffer from Serious Mental Illness—schizophrenia, bipolar
disorder, or major depression—choice is not an option.

Forced Treatment
Already Exists. It’s Called Prison.

Why does this matter? Because right now, Representative Tim
Murphy has proposed legislation that would overhaul our nation’s broken mental
health system, providing much needed treatment to people with serious mental
illness and restoring accountability to SAMHSA, an organization that has
suffered from a massive dose of mission creep. HR 3717, the
“Helping Families in Mental Health Crisis Act,” was drafted after extensive
consultation with parents like me, consumers of mental health care, law
enforcement professionals, and other stakeholders in this increasingly serious
mental health crisis that has created an environment where mass shootings or stabbings barely make the news anymore.

But community organizations are out in full force against
the bill. I know this, because as I mentioned, I volunteer for many
organizations, and I am on their mailing lists. The primary rallying cry
against the bill seems to be the idea of “forced treatment,” or treating people
against their will. Here’s an example of the type of language they are using:

[HR
3717] is intentionally designed to make it sound benign and to gloss over the
potential harm and many rights violations. For example, 'increase access to
mental health treatment,' in many instances, means increased force. Empowering
'family members' means taking away privacy protections and rights to
confidentiality for adults in mental health services. Expanding 'access to
evidence-based treatments,' means eliminating access to alternatives that don't
have the funds to become 'evidence-based.' Advancing 'medical research' means
severely reducing funds to other groups and organizations, including the
Substance Abuse and Mental Health Services Administration (SAMHSA).

Oh,
I get it. You can’t show any measurable outcomes for your education or anti-stigma or peer support program,
and you are afraid you’ll lose your funding.

As a response, Democrats are rumored to be presenting their
own mental health bill this week,
eliminating the provisions of Murphy’s bill which would have helped families in
mental health crisis the most. What I want to say to these probably
well-meaning representatives is this: forced treatment for people with mental
illness already exists. It’s called prison. E.F. Torrey, the mental health
industry’s Cassandra, issued a clear-eyed warning about treating serious mental
illness in jail back in 1993, and today, the problem is even larger.

What Murphy’s bill actually calls for is Assisted Outpatient Treatment (AOT), and it’s
a proven way to keep people out of jail and off the streets. In drafting HR 3717, Rep.Murphy, a child psychologist, did his homework. He talked to those of us who are living this nightmare. He knows what we need to
prevent another tragedy like what happened to Creigh Deeds, or to countless
other families. I want to ask those representatives who are not supporting Murphy: what did Newtown mean, if
we can’t get help for children and families in mental health crisis?

I’m Okay, You’re Okay

The thing is, I also agree with SAMHSA. For neurotypical
people like me, behavioral health is incredibly important to overall health and
quality of life. I know this firsthand. Like most Americans, I have personally
experienced bouts of situational depression. My senior year of college, I broke
off an engagement. My father was dying of cancer. I could not experience any
joy or imagine any meaning to life. I became passively suicidal and began to
control the only thing I felt I could control: my daily intake of food.

Fortunately, my wonderful roommates intervened and got me help. I
learned to overcome my negative thoughts, to exercise, to practice yoga. I
developed resilience. I am grateful to the therapists, and yes, to the Zoloft,
that got me through that dark period in my life. The tools I learned have
proved invaluable to me as I have faced even greater challenges throughout my
life. And I return to therapy whenever I need an objective third party to help
me realistically assess my situational challenges. I guess you could say I’m in
recovery.

This kind of thing doesn’t work for my son who has bipolar
disorder. Not at all. The recovery model doesn’t work all that well for a
subset of the population who suffer from addiction, either, as Philip Seymour
Hoffman’s tragic death demonstrated.

In “The Lie of Focusing on Those with Serious Mental
Illness,” Dr. John Grohol argued that we should treat all mental illness
equally. I respectfully disagree. We need to provide help and hope to families in
crisis, before the next Newtown, before the next (insert location of most recent
mass shooting). Our current system of forced treatment—prison—or no treatment—homelessness—must end.

5 comments:

Peers are the conscripted army of the SAMSa supported Pamii and Disability Rights groups. They are fervrent in their bias against 3717 for all the reasons that don't stand logical inspection. Problem with many peers is they are self centered and lack emphathy. If they could see the SMI as fellow travelers or as brother and sisters in need rather than dispute their very existance, this bill 3717 would quickly become law....and the money would still flow to them and to those that really need it.

Counter Confetence in DC in Sept. During NAMI conference. Details to come...NAMI will switch to promite the DEM bill, I expect. We need to say...we demand medical treatment, including hospital care, just like any othet illness. I support HR3717, but it doesn't go far enough, in my opinion.

Remove SMI from under SAMHSA's control. Period. Create an SMI Agency...under Neurology, not Behavioral Health. They are Brain illnesses. Other than that HR3717 is almost perfect. Also need a FULL repeal of IMD Exclusion, which HR3717 doesn't do. Those are my two big issues with HR3717. Am very disspointed in Dems. Wish Wellstone was still alive.

Attempts to simplify the problems and reduce them to easy categories with across the board treatments may help some and may help to some extent, but still it doesn't address the myriad of issues that are out there. Mental dysfunction is widespread and those facing it need compassion and to be given a impetus to seek and accept help. There are no one size fits all solutions.

AOT is used some places already. How effective is Kendra's law? They are voting on implementing Laura's law in my county. I admit I am wary of the thought of giving up some rights even though at the moment I don't qualify anyways. But, I do think the freedom to be delusional isn't much of a freedom.

I don't understand Chip's complaint about peers. I have a SMI, schizoaffective disorder, and I think I have some insight that someone from the outside might not have.

What happened to the uproar that we need more treatment to protect society from us?

I also believe stigma isn't as good a term as prejudice. People know what that means and agree it is a negative.

About Me

Liza Long, aka the Anarchist Soccer Mom, is a writer, educator, mental health advocate, and mother of four children. She loves her Steinway, her husband, her kids,and her day job, not necessarily in that order. Her book "The Price of Silence: A Mom's Perspective on Mental Illness" from Hudson Street Press is available in bookstores and online. The views expressed on this blog are entirely her own and in no way reflect the views of her employer (or anyone else, for that matter).